Relationships between skeletal maturity estimated from hand-wrist radiographs and the timing of the adolescent growth spurt.

The roles of ossification events, bone stages and bone ages in the prediction of the timing of the pubertal growth spurt are examined using data from the Harpenden growth study. In general, predictions made more than two years in advance of the average age of peak height velocity (PHV) are of little clinical value. The timings of certain ossification events and of PHV are related but the practical difficulties of obtaining reliable information on their timings precludes their use in most circumstances. Certain bone stages may be used to indicate that growth is nearly completed. RUS bone age is more closely related to the timing of PHV than is carpal age, and it is the most convenient and reliable way of estimating the age at PHV, although the confidence limits of such a prediction are appreciable. It may be very misleading to assume that the growth spurt will be advanced or delayed to the same extent as ossification events or bone age and the appropriate regression equations must be used.